The use of administrative health care databases to identify patients with Rheumatoid Arthritis

Objective: To validate and compare the decision rules to identify rheumatoid arthritis (RA) in administrative databases. Methods: A study was performed using administrative health care data from a population of 1 million people who had access to universal health care. Information was available on hospital discharge abstracts and physician billings. RA cases in health administrative databases were matched 1:4 by age and sex to randomly selected controls without inflammatory arthritis. Seven case definitions were applied to identify RA cases in the health administrative data, and their performance was compared with the diagnosis by a rheumatologist. The validation study was conducted on a sample of individuals with administrative data who received a rheumatologist consultation at the Arthritis Center of Nova Scotia. Results: We identified 535 RA cases and 2,140 non-RA, noninflammatory arthritis controls. Using the rheumatologist's diagnosis as the gold standard, the overall accuracy of the case definitions for RA cases varied between 68.9% and 82.9% with a kappa statistic between 0.26 and 0.53. The sensitivity and specificity varied from 20.7% to 94.8% and 62.5% to 98.5%, respectively. In a reference population of 1 million, the estimated annual number of incident cases of RA was between 176 and 1,610 and the annual number of prevalent cases was between 1,384 and 5,722. Conclusion: The accuracy of case definitions for the identification of RA cases from rheumatology clinics using administrative health care databases is variable when compared to a rheumatologist's assessment. This should be considered when comparing results across studies. This variability may also be used as an advantage in different study designs, depending on the relative importance of sensitivity and specificity for identifying the population of interest to the research question

A Longitudinal Study of Ambulatory Physician Encounters, Emergency Room Visits, and Hospitalizations by Patients with Rheumatoid Arthritis: A 13-year Population Health Study

Objective. To determine total physician encounters, emergency room (ER) visits, and hospitalizations in an incident cohort of rheumatoid arthritis (RA) cases and matched control patients over 13 years. Methods. A retrospective cohort study was performed using administrative healthcare data from about 1 million people with access to universal healthcare. Using the International Classification of Diseases, 9th ed (ICD-9) and ICD-10 diagnostic codes, 7 RA case definitions were used. Each case was matched by age and sex to 4 randomly selected controls. Data included physician billings, ER visits, and hospital discharges over 13 years. Results. The number of incident RA cases varied from 3497 to 27,694, depending on the case definition. The mean age varied from 54.3 to 65.0 years, and the proportion of women from 67.8% to 71.3%. The number of physician encounters by patients with RA was significantly higher than by controls. It was highest in the index year and declined promptly thereafter for all case definitions and by 12.2%–46.8% after 10 years. Encounters with subspecialty physicians fell by 61% (rheumatologists) and 34% (internal medicine). In contrast, clinical encounters with family physicians and other physicians fell by only 9%. Visits to the ER and hospital admissions were also significantly higher in RA cases, particularly early in the disease, and fell significantly over the followup. Conclusion. In patients with RA, healthcare use is highest in the first year following the diagnosis, which is also the time of maximal involvement by rheumatologists. Use declines over time, and encounters with patients’ family physicians predominate over other physician groups

Working with gay and lesbian youth : the counselor as advocate

This paper addresses the challenges and barriers that gay and lesbian adolescent youth face during this period of t development. It specifically examines the feelings and stages of the coming out process and how gay and lesbian youth deal with this challenging time. The remainder of the paper outlines the role of the counselor in helping gay and lesbian youth. The paper addresses individual, group, and classroom interventions that may be used in assisting this marginalized population

Replication in second language research : Narrative and systematic reviews, and recommendations for the field.

Despite its critical role for the development of the field, little is known about replication in second language (L2) research. To better understand replication practice, we first provide a narrative review of challenges related to replication, drawing on recent developments in psychology. This discussion frames and motivates a systematic review, building on syntheses of replication in psychology, education, and L2 research. We coded 67 self-labeled L2 replication studies found across 26 journals for 136 characteristics. We estimated a mean rate of 1 published replication study for every 400 articles, with a mean of 6.64 years between initial and replication studies and a mean of 117 citations of the initial study before a replication was published. Replication studies had an annual mean of 7.3 citations, much higher than averages in linguistics and education. Overlap in authorship between initial and replication studies and the availability of the initial materials both increased the likelihood of a replication supporting the initial findings. Our sample contained no direct (exact) replication attempts, and changes made to initial studies were numerous and wide ranging, which likely obscured, if not undermined, the interpretability of replication studies. To improve the amount and quality of L2 replication research, we propose 16 recommendations relating to rationale, nomenclature, design, infrastructure, and incentivization for collaboration and publication

Attachment and couple sexual functioning

Within the last several years, there has been a surge in the publications that focus on attachment within the couple relationships, including how it pertains to infidelity treatment. Despite the interest in couple relationships and attachment, however, a limited amount of literature focuses on how varying styles of attachment manifest in a couple\u27s level of sexual functioning. This study is a response to the need to explore the literature and related gaps in literature

A descriptive analysis of children seeking medical attention for problematic sexualized behavior

IntroductionProblematic Sexualized Behavior (PSB) in children is an increasingly prevalent and often misunderstood issue that impacts the well-being of children. Quantifying the numbers of affected children is challenging due to inconsistencies in how these children are identified, as well as misperceptions surrounding the issue and lack of a coordinated community response.MethodsIn this single-center retrospective case review, we attempt to report data on child demographics and case characteristics for children presenting to one Child Protection Program (CPP) medical specialty team for concern of PSB.ResultsA total of 224 children were identified as having engaged in PSB during the study period. 110 (49%) of these children were referred to the CPP for medical evaluation and medically triaged by the team. The remaining 114 children (51%) were identified through the medical triage of the presenting cases as having engaged in PSB with the index children, but were not referred to CPP for medical care themselves. The majority of children who were referred (69%) were the recipient of the PSB, compared to being the displayer of the behavior (20%). Of the recipient cases, the child displaying PSB was also referred to the CPP only 14.5% of the time.DiscussionThese results highlight that the number of children presenting for medical evaluation with concern of PSB is a significant underestimation of the prevalence of PSB in the community. This notable gap in identification of children engaging in PSB prevents service delivery for these children, including medical evaluation. The results also demonstrate that children displaying PSB were disproportionately missing from care and represent a specific area of missed opportunity for intervention and support by medical professionals

Perspectives and Experiences of Community-Dwelling Older Adults with Falling: An Evidence-Based Practice Project

This project sought to answer the following Evidence-Based Practice (EBP) question: What are the perspectives and experiences of community-dwelling older adults with falling

An analysis of healthcare providers' online ratings

Background Many websites allow consumers to evaluate their healthcare experience yet scant data exist that explore the type and content of reviews. Objective To evaluate and describe online healthcare provider reviews. Methods We analysed 16 703 ratings on 6101 providers from four US cities. Ratings spanned five categories and an overall provider score. We also performed text analyses of narrative commentary (n = 15 952). Results Providers had a high mean score for each category (3.7_4.0 out of 5). Higher overall scores were associated with higher staff (adjusted odds ratio (aOR) 3.0, 95% CI 2.9_3.0, P< 0.01) and punctuality scores (aOR 2.1, 95% CI 2.05_2.15, P< 0.01). Review frequency was inversely associated with scores, (aOR 0.94, 95% CI 0.92_0.96, P<0.01). Analyses of narrative commentaries revealed more positive than negative terms (P< 0.01). Conclusions Online ratings were largely positive. Future research must discern how online surveys affect patient referrals, provider reputations and patients' perceptions of quality of care